Case (16)

[Admin]

Yousuf is a 7-year old Sudanese boy, he has been well about two weeks when his mother noticed that he is less active, and lost weight inspite of good appetite, he also started to wet his bed over the last week, and he develop vomiting and severe abdominal pain over the previous 3 days.

Clinical examination: he is wasted drowsy, dehydrated, temp 37 Cْ 

- Wt 17 kgs

- Pulse 110 /m small vol.

- RR 60/ min, deep in character

- BP 90/50 mmHg

Examination of the heart, lunges, abdomen and lower limbs is normal apart from a distended urinary bladder.
Questions:

1) What is the most likely diagnosis?

2) Mention 3 relevant investigates to confirm the diagnosis?

3) Enumerate the lines of management of the condition.
Dr.Mahdi

[Kassim]

1) What is the most likely diagnosis?
Type 1 Diabetes Mellitus : Type 1 diabetes may also be known by a variety of other names, including:
   insulin-dependent diabetes mellitus (IDDM)
   juvenile diabetes
2) Mention 3 relevant investigates to confirm the diagnosis?
•   Urinalysis shows glucose and ketone bodies in the urine, but a blood test is required for diagnosis
•   Fasting blood glucose is 126 mg/dL or higher
•   Random (nonfasting) blood glucose exceeds 200 mg/dL (this must be confirmed with a fasting test)
•   Insulin test (low or undetectable level of insulin)
•   C-peptide test (low or undetectable level of the protein C-peptide)

3) Enumerate the lines of management of the condition.

The immediate goals of treatment of Yusuf are to treat diabetic ketoacidosis and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization. so Yusuf needs an admission, and observation.
•   The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs.  These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels

hope this is the right answer

[Admin]

Well done, it's the right answer & this child is suffering from DKA.
Congratulations, you have given 15 points for this case.
Dr.mahdi